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WHO Report: Drug-Resistant TB at Crisis Levels

TB/HIV co-epidemic poses key challenge

Efforts to improve the collection and reporting of data on tuberculosis (TB) are shedding new light on the epidemic, revealing that there are almost half a million more cases of the disease than previously estimated, according to a new report from the World Health Organization (WHO). The report shows that 9 million people developed TB worldwide in 2013 and that 1.5 million died, including 360,000 people who were human immunodeficiency virus (HIV)- positive.

The report stresses, however, that the mortality rate from TB is still falling and has dropped by 45% since 1990, while the number of people developing the disease is declining by an average of 1.5% a year. An estimated 37 million lives have been saved through effective diagnosis and treatment of TB since 2000, according to WHO.

“Following a concerted effort by countries, by WHO, and by multiple partners, investment in national surveys and routine surveillance efforts has substantially increased. This is providing us with much more and better data, bringing us closer and closer to understanding the true burden of tuberculosis,” said Dr. Mario Raviglione, director of WHO’s Global TB Program.

Although higher, these revised figures fall within the upper limit of previous WHO estimates. The report, however, underlines that a large number of lives are being lost to a curable disease and confirms that TB is the second biggest killer disease from a single infectious agent. In addition, approximately 3 million people who develop TB are still being “missed” by health systems each year, either because they are not diagnosed or because they are diagnosed but not reported.

Moreover, the multidrug-resistant TB (MDR-TB) crisis continues, with an estimated 480,000 new cases in 2013, the report says. Worldwide, approximately 3.5% of all people who developed TB in 2013 had this form of the disease, which is much harder to treat and has significantly poorer cure rates. While the estimated percentage of new TB cases that have MDR-TB globally remains unchanged, severe epidemics have occurred in some regions, particularly in Eastern Europe and Central Asia. In many settings around the world, the treatment success rate is alarmingly low, according to the report. Further, extensively drug-resistant TB (XDR-TB), which is even more expensive and difficult to treat than MDR-TB, has been reported in 100 countries.

Since 2009, with more laboratories rolling out rapid tests, there has been a tripling of the number of MDR-TB cases being diagnosed. In 2013, 136,000 MDR-TB cases were detected, and 97,000 people were started on treatment. Although the number of patients treated has increased three-fold since 2009, at least 39,000 patients diagnosed with MDR-TB were not treated last year, and globally only 48% of patients were cured, according to the report.

Another key challenge is the global co-epidemic of TB and HIV. An estimated 1.1 million (13%) of the 9 million people who developed TB in 2013 were HIV-positive, with four out of five cases and deaths occurring in the African region. While the number of TB deaths among HIV-positive people has been falling for almost a decade –– from 540,000 in 2004 to 360,000 in 2013 –– antiretroviral treatment, preventive therapy, and other key interventions need to be further scaled-up, the report says.